Fixed suture construct for soft tissue reconstruction

ABSTRACT

Disclose herein are suture anchor constructs. The suture anchor constructs can include an anchor, a first suture, and a second suture. The anchor can include a post and a body. The body can define a central hole extending from a trailing end of the body along a central axis towards a leading end of the body. The first suture can have a first tail, a second tail, and a first intermediate potion located proximate the post. The second suture can have a third tail, a fourth tail, and a second intermediate portion secured to the post. The first, second, third, and fourth, tails can pass through the central hole.

PRIORITY CLAIM

This application claims priority to U.S. Provisional Patent ApplicationNo. 62/954,043, entitled “Fixed Suture Construct for Soft TissueReconstruction,” filed on Dec. 27, 2019, the content of which is herebyincorporated in its entirety.

FIELD OF THE DISCLOSURE

The present disclosure relates to sutures. Specifically, the presentdisclosure relates to fixed sutures for soft tissue reconstructions andmethods of use thereof.

BACKGROUND

Arthroscopic procedures often include sutures and anchors to secure softtissue to bone. Despite their widespread use, sutures and sutureanchors, as well as methods for their use, can be improved. For example,tying sutures to anchors can be very time consuming and difficult toperform. As a result, the cost of the procedure can be increased and thecapacity of the surgeon can be limited. Current suture anchor constructscan include a sliding suture that usually requires a surgeon to tieknots in order to fix the suture to the anchor.

The systems and methods disclosed herein address the issues with slidingsutures.

SUMMARY

To better illustrate the systems and methods disclosed herein, anon-limiting list of examples is provided here.

Example 1 is a suture anchor construct comprising: an anchor including apost and a body, the body defining a central hole extending from atrailing end of the body along a central axis towards a leading end ofthe body; a first suture including a first tail, a second tail, and afirst intermediate portion, the first intermediate portion locatedproximate the post, the first and second tails passing through thecentral hole; and a second suture having a third tail, a fourth tail,and a second intermediate portion, the second intermediate portionsecured to the post, the third and fourth tails passing through thecentral hole.

In Example 2, the subject matter of Example 1 optionally includeswherein the second intermediate portion is located in between the postand the first intermediate portion.

In Example 3, the subject matter of any one or more of Examples 1-2optionally include wherein the first intermediate portion is located inbetween the post and the second intermediate portion.

In Example 4, the subject matter of any one or more of Examples 1-3optionally include wherein the second intermediate portion secured tothe post includes the second intermediate portion forming a hitch knot.

In Example 5, the subject matter of Example 4 optionally includeswherein the hitch knot includes a sliding knot.

In Example 6, the subject matter of any one or more of Examples 1-5optionally include wherein the second intermediate portion secured tothe post includes the second intermediate portion forming a loop that iswrapped around the post and the third and fourth tails passing throughthe loop.

In Example 7, the subject matter of any one or more of Examples 1-6optionally include wherein the post defines a through hole, the secondsuture passing through the through hole and tied into a knot located ata distal end of the through hole.

In Example 8, the subject matter of any one or more of Examples 1-7optionally include wherein the post includes a barb, the barb passingthrough the second intermediate portion.

In Example 9, the subject matter of any one or more of Examples 1-8optionally include wherein the post includes a first portion and asecond portion located in between the first portion and the trailing endof the body, the second intermediate portion wrapped around the firstportion.

In Example 10, the subject matter of any one or more of Examples 1-9optionally include wherein the second intermediate portion secured tothe post includes the second intermediate portion partially surroundingthe post.

In Example 11, the subject matter of any one or more of Examples 1-10optionally include a plug configured to fit into the central hole, theplug including first and second passages, the first tail passing throughthe first passage and the second tail passing through the secondpassage.

In Example 12, the subject matter of any one or more of Examples 1-1loptionally include a pin passing through the second intermediate portionproximate the post.

In Example 13, the subject matter of any one or more of Examples 1-12optionally include a tube located proximate the post, the third andfourth tails passing through the tube.

In Example 14, the subject matter of any one or more of Examples 1-13optionally include wherein the first suture is secured to the post.

Example 15 is a suture anchor construct comprising: an anchor includinga post and a body, the body defining: a central hole extending from atrailing end of the body along a central axis; and a radial hole locatedproximate a leading end of the body and passing through the body, thepost extending from a first portion of the radial hole to a secondportion of the radial hole; a first suture including a first tail, asecond tail, and a first intermediate potion, the first intermediateportion located proximate the post, the first and second tails passingthrough the central hole; and a second suture including a third tail, afourth tail, and a second intermediate portion, the second intermediateportion forming a hitch knot that fixedly secures the second suture tothe post, the third and fourth tails passing through the central hole.

In Example 16, the subject matter of Example 15 optionally includeswherein the second intermediate portion is located in between the postand the first intermediate portion.

In Example 17, the subject matter of any one or more of Examples 15-16optionally include wherein the first intermediate portion is located inbetween the post and the second intermediate portion.

In Example 18, the subject matter of any one or more of Examples 15-17optionally include wherein the hitch knot includes the secondintermediate portion forming a loop that is wrapped around the post.

In Example 19, the subject matter of any one or more of Examples 15-18optionally include wherein the hitch knot includes a sliding knot.

In Example 20, the subject matter of any one or more of Examples 15-19optionally include wherein the post defines a through hole, the secondsuture passing through the through hole, the hitch knot located at adistal end of the through hole.

In Example 21, the subject matter of any one or more of Examples 15-20optionally include wherein the first suture passes through the hitchknot.

In Example 22, the subject matter of any one or more of Examples 15-21optionally include wherein the post includes a barb, the hitch knot tiedto the barb.

In Example 23, the subject matter of any one or more of Examples 15-22optionally include wherein the first suture is secured to the post.

Example 24 is a suture anchor construct comprising: an anchor having apost and a body defining: a central hole extending from a trailing endof the body along a central axis, and a radial hole located proximate aleading end of the body and passing through the body, the post extendingfrom a first portion of the radial hole to a second portion of theradial hole; a first suture having a first tail, a second tail, and afirst intermediate portion located proximate the post, the first andsecond tails passing through the central hole, and a second suturehaving a third tail, a fourth tail, and a second intermediate portionsecured to the post, the third and fourth tails passing through thecentral hole.

In Example 25, the subject matter of Example 24 optionally includeswherein the post includes a first portion and a second portion locatedin between the first portion and the trailing end of the body, thesecond intermediate portion wrapped around the first portion.

In Example 26, the subject matter of any one or more of Examples 24-25optionally include wherein the second intermediate portion secured tothe post includes the post having a barb that passes through the secondintermediate portion.

In Example 27, the subject matter of any one or more of Examples 24-26optionally include wherein the second intermediate portion secured tothe post includes the second intermediate portion partially surroundsthe post.

In Example 28, the subject matter of any one or more of Examples 24-27optionally include a plug configured to fit into the central hole, theplug includes first and second passages, the first tail passing throughthe first passage and the second tail passing through the secondpassage.

In Example 29, the subject matter of any one or more of Examples 24-28optionally include a pin passing through the second intermediate portionproximate the post.

In Example 30, the subject matter of any one or more of Examples 24-29optionally include a tube located proximate the post, the third andfourth tails passing through the tube.

In Example 31, the subject matter of any one or more of Examples 24-30optionally include wherein the first suture is secured to the post.

In Example 32, the suture anchor constructs or methods of any one of orany combination of Examples 1-31 are optionally configured such that allelements or options recited are available to use or select from.

BRIEF DESCRIPTION OF THE FIGURES

The above-mentioned and other features and advantages of thisdisclosure, and the manner of attaining them, will become more apparentand the disclosure itself will be better understood by reference to thefollowing description of embodiments taken in conjunction with theaccompanying drawings, wherein:

FIG. 1 shows a surgical site in accordance with at least one example ofthe present disclosure.

FIG. 2 shows a method in accordance with at least one example of thepresent disclosure.

FIGS. 3-19B each shows a suture anchor construct in accordance with atleast one example of the present disclosure.

Corresponding reference characters indicate corresponding partsthroughout the several views. The exemplifications set out hereinillustrate exemplary embodiments of the disclosure, and suchexemplifications are not to be construed as limiting the scope of thedisclosure in any manner.

DETAILED DESCRIPTION

As disclosed herein, fixed sutures within an anchor can eliminate theneed for a surgeon to tie knots for fixation. The free ends of the fixedsutures can be passed through soft tissue to a knotless anchor for afaster procedure. The suture constructs disclosed herein can include afixed suture configuration where at least one suture is fixed to ananchor without a surgeon having to tie a knot or otherwise secure thesuture to the anchor. As a result, the free ends of a suture can bepassed through soft tissue and directly passed to a knotless anchorresulting in decreased time for a procedure. For example, the free endsof a fixed suture can be passed through the supraspinatus tendon, thesubscapularis tendon, or the infraspinatus tendon during a rotator cuffrepair procedure and then secured to each other using knots.

As used herein proximal refers to a location on a bone anchor that iscloser to the physician. Distal refers to a location on a bone anchorthat is away from the physician. Leading end refers to a tip or distalportion of a bone anchor. Trailing end refers to a tail or proximalportion of a bone anchor.

Turning now to the figures, FIG. 1 shows a surgical site 100 inaccordance with at least one example of the present disclosure. As shownin FIG. 1, surgical site 100 can include a bone 102 in which one or moresuture anchor constructs 104 may be implanted. Each of suture anchorconstructs 104 can include an anchor 106, a first suture 108, and asecond suture 110. Suture anchor constructs 104 can be used to securetissue 112 to bone 102 as disclosed herein. Surgical site 100 canrepresent any surgical procedure where tissue can be attached to orotherwise anchored to bone.

FIG. 2 shows a method 200 for securing tissue to bone and will bedescribed with reference to FIG. 1. During surgery, a surgeon can drillone or more holes 114 in bone 102 (202). Drilling holes 114 can includeusing a drill guide or other surgical instruments to locate holes 114and/or sturdy the drilling equipment used to drill holes 114.

After holes 114 are drilled anchors 106 can be implanted into bone 102(204). Implanting anchors 106 can include using an inserter to screwanchors 106, which can include a threaded exterior surface, into bone102. Anchors 106 can also include barbs, a porous metal coating, and/orother features to secure anchors 106 within holes 104. Thus, anchors 106can be pressed into bone 102 as well as screwed into bone 102.

With anchors 106 securely implanted into bone 102, any combination offirst and second sutures 108 and 110 can be passed thought tissue 112(206). Any one of second sutures 110, which are fixedly secured to arespective anchor 106, can be passed through tissue 112. As disclosedherein, the fixed nature of second suture 110 can allow the surgeon tosecure tissue 112 to bone 102 without the need to first secure secondsuture 110 to anchors 106. First sutures 108 can also be passed throughtissue 112 in preparation for securing tissue 112 to bone 102.

After passing at least one of first sutures 108 or second sutures 110through tissue 112, tissue 112 can be secured to bone 102 (208). Forexample, using second sutures 110, which are now secured to bone 102 inan immovable manner, the surgeon can pull free ends of second sutures110 to apply tension to tissue 112 and manipulate tissue 112 into adesired position. Once tissue 112 is in a desired position, the surgeoncan tie the free ends of first and second sutures 108 and 110 togetheror to other sutures and/or anchors.

By having second sutures 110 secured to anchors 106, time can be savedin the operating room because the surgeon or other medical staff canpass seconds suture 110 through the tissue and have it anchored downwith a knotless anchor, such as anchors 106, before inserting anchors106. In addition, second sutures 110 being secured to anchors 106 canaid the surgeon in positioning tissue 112 due to the fixed nature of aportion of second suture 110.

FIG. 3 shows a suture anchor construct 300, such as suture anchorconstruct 100, in accordance with at least one example of the presentdisclosure. Suture anchor construct 300 can include an anchor 302, afirst suture 304, and a second suture 306. Anchor 302 can include a body308 that defines a central hole 310 and a radial hole 312. Anchor 302can include a post 314 that extends from a first portion of radial hole312 to a second portion of radial hole 312. Stated another way, post 314can span from one side of anchor 302 to another side of anchor 302within radial hole 312. Radial hole 312 and post 314 can be locatedproximate to the leading end of anchor 302.

First suture 304 can include a first tail 316, a second tail 318, and afirst intermediate portion 320 located in between first tail 316 andsecond tail 318. Second suture 306 can include a third tail 322, afourth tail 324, and a second intermediate portion 326 located inbetween third tail 322 and fourth tail 324.

Consistent with embodiments disclosed herein, first suture 304 can befree to move about post 314. By having first suture 304 being free tomove, a surgeon can reposition first suture 304 as need. Byrepositioning first suture 304 the surgeon can adjust the lengths offirst tail 316 and second tail 318 without having to cut first suture304. The surgeon also has the option to tie knots if they want, or theycan remove first suture 304 if they want.

Second suture 306 can be secured to post 314. As shown in FIG. 3, secondintermediate portion 326 can be wrapped around post 314. A knot 328 canbe tied in second intermediate portion 326 to fixedly secure secondsuture 306 to post 314. For example, knot 328 can be sliding or fixedhitch knot. Knot 328 can also be tied first first and anchor 302 canthen be overmolded to form post 314 and secure second suture 306 to post314.

By having second suture 306 secured to post 314, the surgeon caninitially secure tissue to a bone, such as bone 102, in which anchor 302can be implanted. The secured nature of second suture 306 can allow thesurgeon to initially secure tissue, such as tissue 112, to a bone. Forexample, using second suture 306, the surgeon can pass fourth tail 324through the tissue and manipulate fourth tail 324 to position thetissue. Fourth tail 324 can then be tied to third tail 322, first suture304, bone, and/or other anatomical or implanted structures within thepatient.

Tails 316, 318, 322, and 324 can be used to secure the tissue. Forexample, once the tissue is secured using fourth tail 324, the surgeoncan then use first tail 316 and second tail 318 to further secure thetissue.

FIG. 3 shows first suture 304 located in between second suture 306 andan interior surface 330. This configuration can allow first suture 304to move relative to post 314 and second suture 306.

FIG. 4 shows a suture anchor construct 400 in accordance with at leastone example of the present disclosure. Suture anchor construct 400 caninclude an anchor 402, a first suture 404, and a second suture 406.Anchor 402 can include a body 408 that defines a central hole 410 and aradial hole 412. Anchor 402 can include a post 414 that extends from afirst portion of radial hole 412 to a second portion of radial hole 412.Post 414 can define a through-hole 432. Radial hole 412 and post 414 canbe located proximate to a leading end of anchor 402.

First suture 404 can include a first tail 416, a second tail 418, and afirst intermediate portion 420 located in between first tail 416 andsecond tail 418. Second suture 406 can include a third tail 422, afourth tail 424, and a second intermediate portion 426 located inbetween third tail 422 and fourth tail 424. As shown in FIG. 4, firstsuture 404 can pass around post 414. In addition, first tail 416 and/orsecond tail 418 can pass through through-hole 432.

Consistent with embodiments disclosed herein, first suture 404 can befree to move about post 414 as disclosed above with respect to FIG. 4.

Second suture 406 can be secured to post 414. As shown in FIG. 4, secondintermediate portion 426 can be tied into a knot 428. Knot 428 can betied at a midpoint of second suture 406 or at any point along secondsuture 406.

The diameter of through-hole 432 can be smaller than the knot 428. As aresult, knot 428 cannot pass back through through-hole 432. In otherwords, tension on third and fourth tails, 422 and 424, can cause knot428 to become wedged in through-hole 432. While FIG. 4 showsthrough-hole 432 having a cylindrical profile, through-hole 432 can havea conical profile. Thus, as tension in third and fourth tails, 422 and424, is increased, the force applied to knot 428 by the walls ofthrough-hole 432 can increase.

By having second suture 406 secured to post 414, the surgeon caninitially secure tissue to a bone, such as bone 102, in which anchor 402can be implanted. The secured nature of second suture 406 can allow thesurgeon to initially secure tissue, such as tissue 112, to a bone asdisclosed above with respect to FIG. 3.

FIG. 4 shows first suture 404 located in between second suture 406 andan interior surface 430. This configuration can allow first suture 404to move relative to post 414 and second suture 406 as disclosed abovewith respect to FIG. 3. Still consistent with embodiments disclosedherein, first suture 404 can be fixed to post 414. In addition, firstsuture 404 can pass through knot 428.

FIG. 5 shows a suture anchor construct 500 in accordance with at leastone example of the present disclosure. Suture anchor construct 500 caninclude an anchor 502, a first suture 504, and a second suture 506.Anchor 502 can include a body 508 that defines a central hole 510 and aradial hole 512. Anchor 502 can include a post 514 that extends from afirst portion of radial hole 512 to a second portion of radial hole 512.Radial hole 512 and post 514 can be located proximate to a leading endof anchor 502.

First suture 504 can include a first tail 516, a second tail 518, and afirst intermediate portion 520 located in between first tail 516 andsecond tail 518. Second suture 506 can include a third tail 522, afourth tail 524, and a second intermediate portion 526 located inbetween third tail 522 and fourth tail 524.

Consistent with embodiments disclosed herein, first suture 504 can befree to move about post 514 as disclosed above with respect to FIG. 3.

Second suture 506 can be secured to post 514. As shown in FIG. 5, secondintermediate portion 526 can be wrapped around post 514. A pin 536 canpass through second intermediate portion 526 to fixedly secure secondsuture 506 to post 514.

By having second suture 506 secured to post 514, the surgeon caninitially secure tissue to a bone, such as bone 102, in which anchor 502can be implanted. The secured nature of second suture 506 can allow thesurgeon to initially secure tissue, such as tissue 112, as disclosedabove with respect to FIG. 3.

FIG. 5 shows first suture 504 located in between second suture 506 andan interior surface 530. This configuration can allow first suture 504to move relative to post 514 and second suture 506 as disclosed abovewith respect to FIG. 3. Still consistent with embodiments disclosedherein, first suture 504 can be fixed to post 514. For example, pin 536can pass through first suture 504 just as with second suture 506. Inaddition, a second pin (not shown) can pass through first suture 504 tosecond suture 506.

FIG. 6 shows a suture anchor construct 600 in accordance with at leastone example of the present disclosure. Suture anchor construct 600 caninclude an anchor 602, a first suture 604, and a second suture 606.Anchor 602 can include a body 608 that defines a central hole 610 and aradial hole 612. Anchor 602 can include a post 614 that extends from afirst portion of radial hole 612 to a second portion of radial hole 612.Radial hole 612 and post 614 can be located proximate to a leading endof anchor 602.

First suture 604 can include a first tail 616, a second tail 618, and afirst intermediate portion 620 located in between first tail 616 andsecond tail 618. Second suture 606 can include a third tail 622, afourth tail 624, and a second intermediate portion 626 located inbetween third tail 622 and fourth tail 624.

Consistent with embodiments disclosed herein, first suture 604 can befree to move about post 614 as disclosed above with respect to FIG. 3.

Second suture 606 can be secured to post 614. As shown in FIG. 6, post614 can include a protrusion or barb 640. Barb 640 can extend from adistal side of post 614. Barb 640 can include a point that can allowbarb 640 to pierce and pass through second suture 606. Still consistentwith embodiments disclosed herein, second suture 606 can be tied to barb640 instead of or in addition to being punctured by barb 640.

By having second suture 606 secured to post 614, the surgeon caninitially secure tissue to a bone, such as bone 102, in which anchor 602can be implanted. The secured nature of second suture 606 can allow thesurgeon to initially secure tissue, such as tissue 112, as disclosedabove with respect to FIG. 3.

First suture 604 can move relative to post 614 and second suture 606 asdisclosed above with respect to FIG. 3. Still consistent withembodiments disclosed herein, first suture 604 can be fixed to post 614.For example, barb 640 can pass through first suture 604 or first suture604 can be tied to barb 640 just as with second suture 606.

FIG. 7 shows a suture anchor construct 700 in accordance with at leastone example of the present disclosure. Suture anchor construct 700 caninclude an anchor 702, a first suture 704, and a second suture 706.Anchor 702 can include a body 708 that defines a central hole 710 and aradial hole 712. Anchor 702 can include a post 714 that extends from afirst portion of radial hole 712 to a second portion of radial hole 712.Radial hole 712 and post 714 can be located proximate to a leading endof anchor 702.

First suture 704 can include a first tail 716, a second tail 718, and afirst intermediate portion 720 located in between first tail 716 andsecond tail 718. Second suture 706 can include a third tail 722, afourth tail 724, and a second intermediate portion 726 located inbetween third tail 722 and fourth tail 724.

First suture 704 and second suture 706 can be secured to post 714. Asshown in FIG. 7, post 714 can define a hole 738 which can divide post714 into two portions. Tails 716, 718, 722, and 724 can be passedthrough hole 738 and wrapped around a distal portion of post 714. Asshown in FIG. 7, first suture 704 and second suture 706 can be woventogether to further secure first suture and second suture 706 to thedistal portion of post 714.

By having first suture 704 and second suture 706 secured to post 714,the surgeon can initially secure tissue to a bone, such as bone 102, inwhich anchor 702 can be implanted. The secured nature of first suture704 and second suture 706 can allow the surgeon to initially securetissue, such as tissue 112, to a bone as disclosed above with respect toFIG. 3.

FIG. 8 shows a suture anchor construct 800 in accordance with at leastone example of the present disclosure. Suture anchor construct 800 caninclude an anchor 802 and a first suture 804. Anchor 802 can include abody 808 that defines a central hole 810 and a radial hole 812. Anchor802 can include a post 814 that extends from a first portion of radialhole 812 to a second portion of radial hole 812. Radial hole 812 andpost 814 can be located proximate to a leading end of anchor 802.

First suture 804 can include a first tail 816, a second tail 818, and afirst intermediate portion 820 located in between first tail 816 andsecond tail 818. While not shown, suture construct 800 can include asecond suture as with other suture constructs disclosed herein.

First suture 804 can be secured to post 814. As shown in FIG. 8, post814 can define a hole 838 which can divide post 814 into two portions.Tails 816 and 818 can be passed through hole 838 and wrapped around aproximal portion of post 814. In leu of a knot, a plug 840 can beinserted into central hole 810. Upon insertion of plug 840, plug 840 canbecome wedged into central hole 810. Friction between body 808, firstsuture 804 and plug 840 can secure first suture to anchor 802.

As disclosed herein, by having first suture 804 secured to post 814 thesurgeon can initially secure tissue to a bone as disclosed above withrespect to FIG. 3.

FIG. 9 shows a suture anchor construct 900 in accordance with at leastone example of the present disclosure. Suture anchor construct 900 caninclude an anchor 902 and a first suture 904. Anchor 902 can include abody 908 that defines a central hole 910 and a radial hole 912. Anchor902 can include a post 914 that extends from a first portion of radialhole 912 to a second portion of radial hole 912. Radial hole 912 andpost 914 can be located proximate to a leading end of anchor 902.

First suture 904 can include a first tail 916, a second tail 918, and afirst intermediate portion 920 located in between first tail 916 andsecond tail 918. Second suture 906 can include a third tail 922, afourth tail 924, and a second intermediate portion 926 located inbetween third tail 922 and fourth tail 924.

First suture 904 can be secured to second suture 906. As shown in FIG.9, first intermediate portion 920 and second intermediate portion 926can be tied together. A knot 928 formed by tying first suture 904 andsecond suture 906 together can be located at a distal end of post 914.The configuration shown in FIG. 9 allows first suture 904 and secondsuture 906 to move relative to anchor 902, but not relative to oneanother.

FIG. 10 shows a suture anchor construct 1000 in accordance with at leastone example of the present disclosure. Suture anchor construct 1000 caninclude an anchor 1002 and a first suture 1004. Anchor 1002 can includea body 1008 that defines a central hole 1010 and a radial hole 1012.Radial hole 1012 and central hole 1010 can form an eyelet. The eyeletcan be used to secure first suture 1004 to anchor 1002.

First suture 1004 can include a first tail 1016, a second tail 1018, anda first intermediate portion 1020 located in between first tail 1016 andsecond tail 1018. While not shown, suture construct 1000 can include asecond suture or any number of sutures as with other suture constructsdisclosed herein.

First suture 1004 can be secured to anchor 1002. As shown in FIG. 10,first intermediate portion 1020 can be wrapped around a distal portionof body 1008 to form a loop that can be located outside of anchor 1002.First tail 1016 and second tail 1018 can travel back through centralhole 1010 and exit anchor 1002. When anchor 1002 is inserted into bone,first intermediate portion 1020 can be pinched in between body 1008 andthe bone, thus locking first suture 1004 in a fixed portion.

FIG. 11 shows a suture anchor construct 1100 in accordance with at leastone example of the present disclosure. Suture anchor construct 1100 caninclude an anchor having a post 1114 (the anchor body is not shown) anda first suture 1104. The anchor can define a central hole and a radialhole as disclosed herein with respect to other anchors.

First suture 1104 can include a first tail 1116, a second tail 1118, anda first intermediate portion 1120 located in between first tail 1116 andsecond tail 1118. While not shown, suture construct 1100 can include asecond suture or any number of sutures as with other suture constructsdisclosed herein.

First suture 1104 can be secured to the anchor. As shown in FIG. 11,first intermediate portion 1120 can be wrapped around post 1114 and sewntogether. For example, first intermediate portion 1120 can be wrappedaround post 1114 and another short section of suture 1142 can piercedthrough both first tail 1116 and second tail 1118. After piercing firstintermediate portion 1120, suture 1142 can be tied into a knot 1144 tosecure first suture 1104 to post 1114.

The number of short sections of sutures 1142 can equal the number ofregular sutures, such as first suture 1104, or be different. Forexample, a single short section of suture 1142 can pierce any number ofregular sutures. In addition, each regular suture or groups of regularsutures can have their own respective short section of suture 1142.

FIG. 12 shows a suture anchor construct 1200 in accordance with at leastone example of the present disclosure. Suture anchor construct 1200 caninclude an anchor having a post 1214 (the anchor body is not shown) anda first suture 1204. The anchor can define a central hole and a radialhole as disclosed herein with respect to other anchors.

First suture 1204 can include a first tail 1216, a second tail 1218, anda first intermediate portion 1220 located in between first tail 1216 andsecond tail 1218. While not shown, suture construct 1200 can include asecond suture or any number of sutures as with other suture constructsdisclosed herein.

First suture 1204 can be secured to the anchor. As shown in FIG. 12,first intermediate portion 1220 can be wrapped around post 1214 and atube 1250 can be used to secure first suture 1204 to post 1214. Forexample, first intermediate portion 1220 can be wrapped around post 1214and both first tail 1216 and second tail 1218 can be fed through tube1250. Tube 1250 can be tight fitting so as to maintain a position onfirst tail 1216 and second tail 1218 once placed thereon. To securefirst suture 1204 to post 1214 tube 1250 can be pushed until it meetspost 1214.

The number of tubes 1250 can equal the number of regular sutures, suchas first suture 1204 or be different. For example, a tube 1250 can belocated on any number of regular sutures. In addition, each regularsuture or groups of regular sutures can have their own respective tube1250.

Tube 1250 can be a rubber band type device. The rubber band type devicecan be attached to both first tail 1216 and second tail 1218. The rubberband type device can pull first tail 1216 and second tail 1218 togetherto prevent them from sliding.

FIG. 13 shows a suture anchor construct 1300 in accordance with at leastone example of the present disclosure. Suture anchor construct 1300 caninclude an anchor 1302 having a body 1308 that defines a radial hole1312 and a first suture 1304.

First suture 1304 can include a first tail 1316, a second tail 1318, anda first intermediate portion 1320 located in between first tail 1316 andsecond tail 1318. While not shown, suture construct 1300 can include asecond suture or any number of sutures as with other suture constructsdisclosed herein.

First suture 1304 can be secured to anchor 1304. As shown in FIG. 13,first suture 1304 can be passed through radial hole 1312. Once anchor1304 is implanted into bone, first suture 1304 can be compressed inbetween body 1308 and the bone. The compression of first suture 1304 cansecure first suture 1304 into a fixed state.

FIG. 14 shows a suture anchor construct 1400 in accordance with at leastone example of the present disclosure. Suture anchor construct 1400 caninclude an anchor having a post 1414 (the anchor body is not shown) anda first suture 1404. The anchor can define a central hole and a radialhole as disclosed herein with respect to other anchors.

First suture 1404 can include a first tail 1416, a second tail 1418, anda first intermediate portion 1420 located in between first tail 1416 andsecond tail 1418. While not shown, suture construct 1400 can include asecond suture or any number of sutures as with other suture constructsdisclosed herein.

First suture 1404 can be secured to post 1414. As shown in FIG. 14,first intermediate portion 1420 can be wrapped around post 1414 anditself to secure first suture 1404 to post 1414. For example, firstintermediate portion 1420 can be wrapped around post 1214 and both firsttail 1216 and second tail 1218 can be fed through loop 1452 formed byfirst intermediate portion 1420. For instance, first suture 1404 can befolded in half to create loop 1452. Loop 1452 can then be wrapped aroundpost 1414. First tail 1416 and second tail 1418 can then be passedthrough loop 1452.

The number of loops 1452 can equal the number of regular sutures, suchas first suture 1404. For example, a loop 1452 can be formed for eachregular suture. In addition, one or more regular sutures can be passedthrough a loop 1452 formed by a different suture. As a result, a singleloop 1452 can be used to secure one or more sutures to post 1414.

FIG. 15 shows a suture anchor construct 1500 in accordance with at leastone example of the present disclosure. Suture anchor construct 1500 caninclude an anchor having a post 1514 (the anchor body is not shown), afirst suture 1504, and a second suture 1506. Post 1514 can include abarb 1540 that protrudes from a distal portion of post 1514. The anchorcan define a central hole and a radial hole as disclosed herein withrespect to other anchors.

First suture 1504 can include a first tail 1516, a second tail 1518, anda first intermediate portion 1520 located in between first tail 1516 andsecond tail 1518. Second suture 1506 can include a third tail 1522, afourth tail 1524, and a second intermediate portion 1526 located inbetween third tail 1522 and fourth tail 1544.

First suture 1504 and second suture 1506 can be secured to post 1514. Asshown in FIG. 15, first intermediate portion 1520 can be folded to forma loop 1554 and a knot 1556 tied in first suture 1504. Secondintermediate portion 1526 can be folded to form a loop 1558 and a knot1560 tied in second suture 1506. Loops 1554 and 1558 can be placedaround barb 1540 thus, securing first suture 1504 and second suture 1506to the anchor. Knots 1556 and 1560 can be hitch knots or slip nots thatallow loops 1554 and 1558 to collapse onto barb 1540 to prevent firstsuture 1504 and second suture 1506 from slipping off of barb 1540.

FIG. 16 shows a suture anchor construct 1600 in accordance with at leastone example of the present disclosure. Suture anchor construct 1600 caninclude an anchor having a post 1614 (the anchor body is not shown) anda first suture 1604. The anchor can define a central hole and a radialhole as disclosed herein with respect to other anchors.

First suture 1604 can include a first tail 1616, a second tail 1618, anda first intermediate portion 1620 located in between first tail 1616 andsecond tail 1618. While not shown, suture construct 1400 can include asecond suture or any number of sutures as with other suture constructsdisclosed herein.

First suture 1604 can be secured to post 1614. As shown in FIG. 16,first intermediate portion 1620 can wrapped around post 1614. Afterwrapping first intermediate portion 1620 around post 1614, first tail1616 can piece second tail 1618 one or more times to secure first suture1604 to post 1614. While FIG. 16 shows a single suture, the number ofsutures can be greater than one. Each of the sutures can be twistedtogether to both secure the sutures together and to post 1614. Inaddition, each suture can be twisted separately or in combination with asub grouping of sutures.

FIG. 17 shows a suture anchor construct 1700 in accordance with at leastone example of the present disclosure. Suture anchor construct 1700 caninclude an anchor 1702 having a body 1708 and a post 1714 and a firstsuture 1704. The anchor can define a central hole 1710 and a firstradial hole 1714 and a second radial hole 1762.

First suture 1704 can include a first tail 1716, a second tail 1718, anda first intermediate portion 1720 located in between first tail 1716 andsecond tail 1718. While not shown, suture construct 1700 can include asecond suture or any number of sutures as with other suture constructsdisclosed herein.

First suture 1704 and can be secured to post 1714. As shown in FIG. 17,first intermediate portion 1720 can wrap partially around a distal endof post 1714 and through first radial opening 1712. First tail 1716 andsecond tail 1718 can then re-enter central hole 1710 via second radialpassage 1762 and exit anchor 1702. Once anchor 1702 is implanted in bone1764, first suture 1704 can be compressed between bone 1764 and anchor1702.

FIG. 18 shows a suture anchor construct 1800 in accordance with at leastone example of the present disclosure. Suture anchor construct 1800 caninclude an anchor having a post 1814 (the anchor body is not shown), afirst suture 1804, and a second suture 1806. The anchor can define acentral hole and a radial hole as disclosed herein with respect to otheranchors.

First suture 1804 can include a first tail 1816 and a second tail 1818tied into a knot 1866. Second suture 1806 can include a third tail 1822and a fourth tail 1824 tied into a knot 1868. The size of knots 1866 and1868 are such that they will not fit through a through hole 1832. WhileFIG. 18 shows first suture 1804 and second suture 1806 tiedindividually, first suture 1804 and second suture 1806 can be tiedtogether.

FIG. 19A shows a suture anchor construct 1900 in accordance with atleast one example of the present disclosure. Suture anchor construct1900 can include an anchor 1902, a first suture 1904, and a secondsuture 1906. First suture 1904 can include a first tail 1916, a secondtail 1918, and a first intermediate portion 1920 located in betweenfirst tail 1916 and second tail 1918. Second suture 1906 can include athird tail 1922, a fourth tail 1924, and a second intermediate portion1926 located in between third tail 1922 and fourth tail 1924.

Anchor 1902 can be formed from a braided material, such as suturematerials. As shown FIG. 19B, the braided material can be formed from aplurality of strands 1956. Also as shown in FIG. 19B, first suture 1904and second suture 1906 can pass in between various strands 1954 topenetrate anchor 1902. To pass first suture 1904 and second suture 1906in between the various strands 1954, a snare (not shown) can be used.The snare can include a wire that forms a loop or hook that can first bepassed through anchor 1902. First suture 1904 and second suture 1906 canthen be passed through the loop or hook of the snare and pulled throughanchor 1902.

As shown in FIG. 19A, second intermediate portion 1926 can be tied intoa knot 1928. Knot 1928 can secure second suture 1906 to anchor 1902.Knot 1928 can be bigger than the space between the various strands 1954used to form anchor 1902. The larger size of knot 1928 can hindermovement of second suture 1906 upon implanting anchor 1902.

Suture anchor construct 1900 by passing first suture 1904 and secondsuture 1906 through anchor 1902 as described herein and forming knot1928 to secure second suture 1906 to anchor 1902. Suture anchorconstruct 1900 can also be prepared by the manufacturer and deliveredwith first suture 1904 and second suture 1906 already connected toanchor 1902 with knot 1928 already formed to secure second suture 1906to anchor 1902.

During surgery, the surgeon can use an inserter to press anchor 1902into a hole drilled into bone. Upon extracting the inserter, anchor 1902can remain in the hole and expand, thereby securing anchor 1902 in thehole. First tail 1916, a second tail 1918, third tail 1922, and a fourthtail 1924 can extend from the hole for use by the surgeon in securingtissue to the bone.

The various knots disclosed herein can be tied in a variety of fashions.The inserter used to install the anchors can be used to pull the knotstight. For example, a suture can be wrapped around the end of theinserter and pushed through a gap such as the central passage in thetrailing end the anchor. The suture can include a pre-tied, but loose,knot located at the end of the inserter that is tightened using theinserter. Tightening the knot can create a suture anchor construct thatis larger than the central passage in the anchor that the suture andinserter shaft are pushed through. The inserter can then be removed andthe suture tied inside the anchor, unable to slide.

It will be readily understood to those skilled in the art that variousother changes in the details, material, and arrangements of the partsand method stages which have been described and illustrated in order toexplain the nature of the inventive subject matter can be made withoutdeparting from the principles and scope of the inventive subject matteras expressed in the subjoined claims.

What is claimed is:
 1. A suture anchor construct comprising: an anchorincluding a post and a body, the body defining a central hole extendingfrom a trailing end of the body along a central axis towards a leadingend of the body; a first suture including a first tail, a second tail,and a first intermediate portion, the first intermediate portion locatedproximate the post, the first and second tails passing through thecentral hole; and a second suture having a third tail, a fourth tail,and a second intermediate portion, the second intermediate portionsecured to the post, the third and fourth tails passing through thecentral hole.
 2. The suture anchor construct of claim 1, wherein thesecond intermediate portion is located in between the post and the firstintermediate portion.
 3. The suture anchor construct of claim 1, whereinthe first intermediate portion is located in between the post and thesecond intermediate portion.
 4. The suture anchor construct of claim 1,wherein the second intermediate portion secured to the post includes thesecond intermediate portion forming a hitch knot.
 5. The suture anchorconstruct of claim 1, wherein the second intermediate portion secured tothe post includes the second intermediate portion forming a loop that iswrapped around the post and the third and fourth tails passing throughthe loop.
 6. The suture anchor construct of claim 1, wherein the postdefines a through hole, the second suture passing through the throughhole and tied into a knot located at a distal end of the through hole.7. The suture anchor construct of claim 1, wherein the post includes afirst portion and a second portion located in between the first portionand the trailing end of the body, the second intermediate portionwrapped around the first portion.
 8. The suture anchor construct ofclaim 1, wherein the second intermediate portion secured to the postincludes the second intermediate portion partially surrounding the post.9. The suture anchor construct of claim 1, further comprising a tubelocated proximate the post, the third and fourth tails passing throughthe tube.
 10. The suture anchor construct of claim 1, wherein the firstsuture is secured to the post.
 11. A suture anchor construct comprising:an anchor including a post and a body, the body defining: a central holeextending from a trailing end of the body along a central axis; and aradial hole located proximate a leading end of the body and passingthrough the body, the post extending from a first portion of the radialhole to a second portion of the radial hole; a first suture including afirst tail, a second tail, and a first intermediate potion, the firstintermediate portion located proximate the post, the first and secondtails passing through the central hole; and a second suture including athird tail, a fourth tail, and a second intermediate portion, the secondintermediate portion forming a hitch knot that fixedly secures thesecond suture to the post, the third and fourth tails passing throughthe central hole.
 12. The suture anchor construct of claim 11, whereinthe second intermediate portion is located in between the post and thefirst intermediate portion.
 13. The suture anchor construct of claim 11,wherein the hitch knot includes the second intermediate portion forminga loop that is wrapped around the post.
 14. The suture anchor constructof claim 11, wherein the post defines a through hole, the second suturepassing through the through hole, the hitch knot located at a distal endof the through hole.
 15. The suture anchor construct of claim 11,wherein the first suture is secured to the post.
 16. A suture anchorconstruct comprising: an anchor having a post and a body defining: acentral hole extending from a trailing end of the body along a centralaxis, and a radial hole located proximate a leading end of the body andpassing through the body, the post extending from a first portion of theradial hole to a second portion of the radial hole; a first suturehaving a first tail, a second tail, and a first intermediate portionlocated proximate the post, the first and second tails passing throughthe central hole; and a second suture having a third tail, a fourthtail, and a second intermediate portion secured to the post, the thirdand fourth tails passing through the central hole.
 17. The suture anchorconstruct of claim 16, wherein the post includes a first portion and asecond portion located in between the first portion and the trailing endof the body, the second intermediate portion wrapped around the firstportion.
 18. The suture anchor construct of claim 16, wherein the secondintermediate portion secured to the post includes the secondintermediate portion partially surrounds the post.
 19. The suture anchorconstruct of claim 16, further comprising a plug configured to fit intothe central hole, the plug includes first and second passages, the firsttail passing through the first passage and the second tail passingthrough the second passage.
 20. The suture anchor construct of claim 16,further comprising a tube located proximate the post, the third andfourth tails passing through the tube.